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Joar Sivertsen, Hanne Braathen, Turid Helen F Lunde, Philip C Spinella, Warren Dorlac, Geir Strandenes, Torunn O Apelseth, Tor A Hervig, Einar K Kristoffersen, Level Iv Diagnostic Study
No abstract text is available yet for this article.
March 12, 2018: Journal of Trauma and Acute Care Surgery
Peter Anders Christensen
Austere care of the wounded is challenging for all Western medical professionals-nurse, medic, or physician. There can be no doubt that working for the first time, either for a nongovernment organization or in the Special Forces, you will be taking care of wounded patients outside your training and experience. You must have the ability to adapt to and overcome lack of resources and equipment, and accept standards of treatment often very different and lower than that common in western hospitals. The International Committee of the Red Cross (ICRC) was asked to provide relief for the Pakistan Red Crescent in 1982 and set up the ICRC Hospital for Afghan War Wounded in Peshawar on the border to Afghanistan...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Jonathan W Brandon, Justin K Solarczyk, Timur S Durrani
Lead toxicity is an important environmental disease and its effects on the human body can be devastating. Unique exposures to Special Operations Forces personnel may include use of firing ranges, use of automotive fuels, production of ammunition, and bodily retention of bullets. Toxicity may degrade physical and psychological fitness, and cause long-term negative health outcomes. Specific effects on fine motor movements, reaction times, and global function could negatively affect shooting skills and decision-making...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Elliot M Ross, Theodore T Redman
BACKGROUND: Noncompressible junctional and truncal hemorrhage remains a significant cause of combat casualty death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective treatment for many junctional and noncompressible hemorrhages. The current hospital standard for time of placement of REBOA is approximately 6 minutes. This study examined the training process and the ability of nonsurgical physicians to apply REBOA therapy in an austere field environment. METHODS: This was a skill acquisition and feasibility study...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Charles Handford, F Reeves, P Parker
In order to continue to deliver outstanding medical care on the battlefield, the UK Defence Medical Services must continue to adapt, overcome and actively embrace change. One potential area is the rapid proliferation and sophistication of automated and remote systems such as unmanned aerial vehicles (UAVs). UAVs are already used to deliver blood to remote military locations in Afghanistan and defibrillators to those that need them in the USA and Sweden. An area of future opportunity would be to facilitate rapid evacuation of wounded personnel from high intensity, high threat, remote and austere areas directly to specialist care...
March 9, 2018: Journal of the Royal Army Medical Corps
Matthieu Komorowski, Sarah Fleming, Mala Mawkin, Jochen Hinkelbein
Future space exploration missions will take humans far beyond low Earth orbit and require complete crew autonomy. The ability to provide anaesthesia will be important given the expected risk of severe medical events requiring surgery. Knowledge and experience of such procedures during space missions is currently extremely limited. Austere and isolated environments (such as polar bases or submarines) have been used extensively as test beds for spaceflight to probe hazards, train crews, develop clinical protocols and countermeasures for prospective space missions...
2018: NPJ Microgravity
Benjamin D Johansen, Rebecca S Blue, Tarah L Castleberry, Erik L Antonsen, James M Vanderploeg
INTRODUCTION: With the development of the commercial space industry, growing numbers of spaceflight participants will engage in activities with a risk for pulmonary injuries, including pneumothorax, ebullism, and decompression sickness, as well as other concomitant trauma. Medical triage capabilities for mishaps involving pulmonary conditions have not been systematically reviewed. Recent studies have advocated the use of point-of-care ultrasound to screen for lung injury or illness. The operational utility of portable ultrasound systems in disaster relief and other austere settings may be relevant to commercial spaceflight...
February 1, 2018: Aerospace Medicine and Human Performance
Mohamed A T Mohamed, Tareq Maraqa, Matthew D Bacchetta, Michael McShane, Kenneth L Wilson
Introduction: Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been gaining use to bridge the recovery from acute respiratory distress syndrome (ARDS) refractory to conventional treatment. However, these interventions are often limited to higher echelons of military care. We present a case of lung salvage from severe ARDS in an Afghani soldier with VV-ECMO at a Role-2 (R2) facility in an austere military environment in Afghanistan. Case: A 25-year-old Afghani soldier presented to an R2 facility with blast lung injury and multiple penetrating injuries following an explosion...
February 13, 2018: Military Medicine
Jeremy W Cannon, Phillip E Mason, Andriy I Batchinsky
Advanced extracorporeal therapies have been successfully applied in the austere environment of combat casualty care over the previous decade. In this review, we describe the historic underpinnings of extracorporeal membrane oxygenation (ECMO), review the recent experience with both partial and full lung support during combat operations, and critically assess both the current status of the Department of Defense ECMO program and the way forward to establish long-range lung rescue therapy as a routine capability for combat casualty care...
February 13, 2018: Journal of Trauma and Acute Care Surgery
Edward Rogers, C Wright, P King
This paper describes the selection of fentanyl as a replacement for morphine as the United Kingdom Ministry of Defence's first-line battlefield analgesic agent. It is a detailed review of the 6 year journey from selection to eventual roll-out in October 2017. It concentrates on the procurement and governance process of the deployment of fentanyl for individual issue and self-use. It highlights the significant differences in military and civilian legislation, the specialist environment we work in and the safety concerns surrounding controlled drugs in the austere environment...
February 12, 2018: Journal of the Royal Army Medical Corps
Lucas A Johnson, Robert P Lennon
Background: Global health engagement (GHE) is an important priority for the Military Health Service as such activities strengthen the health capabilities of partner nations and improve interoperability. By their very nature, GHE activities are predominantly conducted in low-resource areas with limited infrastructure and substantial humanitarian need. The Department of Defense is evaluating leaner, flexible force packages to accomplish GHE missions and better prepare uniformed medical providers to provide care in austere environments...
February 6, 2018: Military Medicine
Matthew J Carr, Christopher Oxner, Eric A Elster, Eric M Ritter, Diego Vicente
Management of complex acute surgical pathology in austere environments necessitates rapid evaluation and resource appropriate management to avoid time-associated morbidity and potentially mortality. Obstructive upper gastrointestinal (UGI) pathologies can be particularly challenging and associated with significant morbidity. Herein, we present six patients with UGI obstructions encountered over the course of an 8-mo deployment onboard a US Navy Aircraft Carrier. Each patient presented to our medical department with signs and symptoms of obstructive UGI pathology including one gastric volvulus requiring operative management at sea, one with a new diagnosis of achalasia requiring transportation and continental United States outpatient evaluation, and four patients with food impaction requiring urgent endoscopic management...
February 6, 2018: Military Medicine
Archana Ashokan, Akshaya Nagrajan Hegde, Anushanthy Balasingham, Rupshi Mitra
Rats are widely used animal models for biological psychiatry and neuroscience. Laboratory rats are typically housed in impoverished sensory environments. The lack of species-typical sensory environment might radically change the response of individual animals to stressful and/or threatening episodes. In this report, we demonstrate that behavioral and neural sequelae of chronic stress were modified by sensory environment of adult male rats. This includes effects of stress on the density of spines on CA3 hippocampal neurons, hippocampal neurogenesis and abundance of glucocorticoid or mineralocorticoid receptors...
February 1, 2018: Brain Research
Shibani Pati, Zhanglong Peng, Katherine Wataha, Byron Miyazawa, Daniel R Potter, Rosemary A Kozar
In severe trauma and hemorrhage the early and empiric use of fresh frozen plasma (FFP) is associated with decreased morbidity and mortality. However, utilization of FFP comes with the significant burden of shipping and storage of frozen blood products. Dried or lyophilized plasma (LP) can be stored at room temperature, transported easily, reconstituted rapidly with ready availability in remote and austere environments. We have previously demonstrated that FFP mitigates the endothelial injury that ensues after hemorrhagic shock (HS)...
2018: PloS One
Fraser John Gould
Acute shoulder dislocation is a common injury in the outdoor environment. The objective of this systematic review of the literature was to determine if intra-articular local anesthetic (IAL) is an effective treatment that could have prehospital application. A methodical search of MEDLINE, PubMed, and EMBASE databases targeted publications from January 1, 1990 until January 1, 2017. Eligible articles compared IAL with other analgesic techniques in patients 16 years or older experiencing acute glenohumeral dislocation...
January 16, 2018: Wilderness & Environmental Medicine
Zubair Ahmed Khan, Ahsin M Bhatti, Faisal Akhtar
Pakistan is prone to floods. In 2010, floods in North-Western Pakistan caused devastation in wide areas. Electro-medical equipment is very expensive and without proper equipment adequate surgery is not possible. We retrospectively analyzed how expensive electro-medical equipment got damaged during floods of 2010 at a district-level hospital in North-Western Pakistan and how we could have saved this equipment or reduced the damage to the minimum. The article provides the lessons learned and recommendations aimed to prevent or minimize damage to the valuable and expensive equipment in the areas prone to floods...
January 21, 2018: Disaster Medicine and Public Health Preparedness
Matt Howard, J Bakker-Dyos, L Gallagher, J P O'Hara, D Woods, A Mellor
INTRODUCTION: The British Service Dhaulagiri Research Expedition (BSDMRE) took place from 27 March to 31 May 2016. The expedition involved 129 personnel, with voluntary participation in nine different study protocols. Studies were conducted in three research camps established at 3600, 4600 and 5140 m and involved taking and storing blood samples, cardiac echocardiography and investigations involving a balance plate. Research in this remote environment requires careful planning in order to provide a robust and resilient power plan...
December 25, 2017: Journal of the Royal Army Medical Corps
Benoît Clavier, Thomas Pouget, Anne Sailliol
BACKGROUND: Life-threatening situations requiring blood transfusion under extreme conditions or in remote and austere locations, such as the battlefield or in traffic accidents, would benefit from reliable blood typing practices that are easily understood by a nonscientist or nonlaboratory technician and provide quick results. STUDY DESIGN AND METHODS: A simplified protocol was developed for the lateral flow-based device MDmulticard ABO-D-Rh subgroups-K. Its performance was compared to a reference method (PK7300, Beckman Coulter) in native blood samples from donors...
February 2018: Transfusion
Kerry E Preston, Rebecca L Corwin, Julia O Bader, Stephen L Crimmins
Housing and enrichment conditions are essential factors to consider when using animal models of behavior, as they can alter the behavior that is under investigation. The goal of this study was to determine the impact of the relatively enriched environment recommended by current animal care guidelines on development and maintenance of binge-type behavior in rats, using the limited access (LA) binge model. Non-food-deprived rats were divided into two groups, enriched and nonenriched, with all rats housed in shoebox cages...
February 1, 2018: Physiology & Behavior
Terence Gourlay, C Simpson, C A Robertson
INTRODUCTION: Uncontrolled haemorrhage is the leading cause of death on the battlefield, and two-thirds of these deaths result from non-compressible haemorrhage. Blood salvage and autotransfusion represent an alternative to conventional blood transfusion techniques for austere environments, potentially providing blood to the casualty at point of injury. The aim of this paper is to describe the design, development and initial proof-of-concept testing of a portable blood salvage and autotransfusion technology to enhance survivability of personnel requiring major medical interventions in austere or military environments...
October 26, 2017: Journal of the Royal Army Medical Corps
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